1. Priyo Budi Purwono, dr Kuliah Mikrobiologi

3. Introduction  “Human Immunodeficiency Virus”  A specific type of virus (a retrovirus)  An enveloped virus, 100 nm diameter  ss +RNA genome  enzyme reverse transcriptase  Receptor : CD4 molecule of T helper lymphocyte, macrophages

4. AIDS  Acquired Immunodeficiency Syndrome  HIV is the virus that causes AIDS  Disease limits the body’s ability to fight infection  A person with AIDS has a very weak immune system  High risk of Opprtunistic Infection

6. New HIV Infections in 2002 by Age Group

7. HIV

9. The Role of T lymphocyte

10. Transmission (body fluid)  3 i :  Intrauterine, or post partum, mother to child infection (vertical infection)  Intravenous : tranfusion, needle stick injury  Intercourse, genital lession/ ulceration

11. High Risk Group for HIV infection  Intra vena drug user (NAPZA)  Unhealthy sexual behaviour  HIV infected sexual partner  Blood tranfussion  Health care worker

13. Stage 1 – Seroconvertion illness  10-50%  Short, flu-like illness - occurs one to six weeks after infection  “window period”  Serology test and western blot negative  RNA viral load may positif  Infected person can infect other people

14. Stage 2 - Asymptomatic  Lasts for several years  This stage is free from symptoms  The virus is not latent, but multiplying actively in cell  HIV antibodies are detectable in the blood

15. Stage 3 – Persistent Generalised Lymphadenopathy (PGL)  Painless  Symetrical  25 % asymtomatic

16. Stage 4 – AIDS related features or Complex (ARC)  The immune system weakens  Oral or vaginal candidiasis  Cervical dysplasia, carcinoma  Chronic diarrhea  Sel CD4 >200/µl

17. Stage 5 - AIDS  20 AIDS defining illnesses (ADIs)  Opportunistic infection occure  HIV encephalopathy  Wasting syndrome (loss of BW >10%)  Fever and chronic diarhhoea  CD4 count <200

18. Opportunistic Infections associated with AIDS  Bacterial Tuberculosis (TB) Strep pneumonia  Viral Kaposi Sarcoma (HHV 8) CMV Herpes simplex

19. Opportunistic Infections associated with AIDS  Parasitic Pneumocystis carinii Toxoplasmosis  Fungal Candida Cryptococcus

20. Blood Detection Tests  Enzyme-Linked Immunosorbent Assay/Enzyme Immunoassay (ELISA/EIA)  Radio Immunoprecipitation Assay/Indirect Fluorescent Antibody Assay (RIP/IFA)  Western Blot Confirmatory test  Polymerase Chain Reaction (PCR)  Viral load HIV

22. Pre-test Counseling  Transmission  Prevention  Risk Factors  Voluntary & Confidential  Reportability of Positive Test Results

23. Post-test Counseling  Clarifies test results  Need for additional testing  Promotion of safe behavior  Release of results

24. Theraphy  HAART (Highly Active Anti Retroviral Therapy), Triple therapy : 1. 2 NRTI and 1 NNRTI or 2. 2 NRTI and 1 PI NRTI : Nucleoside Reverse Transcriptase Inhibitor NNRTI : Non Nucleoside Reverse Transcriptase Inhibitor PI : Protease Inhibitor

25. Antiretroviral Drugs  Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine)  Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine)  Protease inhibitors Norvir (Ritonavir)

26. Control & Prevention  avoid intravenous drug abuse  Sterile needle for injection  Safe equipment and disposal  Screen blood donor  Safe sex : Prostitution regulation  Sex and Drug abuse education  Stop negatif stigma

27. Question ?  Apakah ibu hamil dengan HIV positif selalu menular pada anak ?  Seorang PSK datang ke LSM dengan membawa hasil tes HIV yang negatif, apa saran/tindakan saudara ?

28. Keep aware !!